MEDICARE: KATIE BRZEZINSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1043684426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE BRZEZINSKI

Provider Business Mailing Address
First Line	:	1017 CRYSTAL LAKE RD W
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-6168
Country	:	US
Telephone Number	:	651-666-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 CRYSTAL LAKE RD W
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-6168
Country	:	US
Telephone Number	:	651-666-0434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	11/23/2015

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Directions to “ KATIE BRZEZINSKI ” Practice Location

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